This dissertation reports the findings of an evaluation of the Five Hospital Homebound Elderly Program in Chicago. The Program is a model long term home care demonstration project which is community-based and provides a unique combination of medical and social supportive services to chronically impaired homebound elderly. The Program differs from most Medicare certified and reimbursed programs and is a potential model for expanded benefit programs now being considered in Congress. The evaluation of the Program encompassed both impact and process issues, utilizing a pre/post test quasi-experimental design with a non-equivalent control group. Within this design, the comprehensive functional status of 122 consecutively admitted Five Hospital clients and of 123 controls was assessed at time of acceptance to service and nine months later, using the Duke/OARS Multidimensional Functional Assessment Questionnaire. The control group consisted of recipients of OAA Title III home-delivered meals who live in an area that is geographically contiguous to the Five Hospital Program's catchment area and who were similarly elderly and impaired. Rates of hospitalization, institutionalization and mortality were also obtained in addition to rates of home care services utilization for both groups. Analysis of pretest data, which was obtained on 75% of newly accepted FHHEP clients and 74% of control group clients, revealed that, overall, the two groups were remarkably similar on measured variables with the exception of. the fact that Five Hospital clients were significantly older (x̄ age 80.4) and more impaired in Instrumental Activities of Daily Living than controls but also enjoyed better social supports. These differences were of interest because advanced age, poor ADL and poor social supports are variables which have been reported to be associated with admission to long term care institutions in the literature. At post test, functional status data were obtained on 83% of experimentals and 81% of controls, with mortality being the major cause of attrition in both groups (12% and 11%, respectively). Major findings derived from the analysis of outcome measures revealed no difference between the two groups with respect to mortality rates. However, bivariate analysis revealed interesting differences between the two groups with respect to the characteristics of subjects who died. Variables which appeared to be similarly and differentially associated with increased incidence of mortality in the two groups were therefore identified and discussed. However, the number of subjects who experienced this outcome in both groups was too small to permit any conclusions to be drawn. The fact that mortality rates were almost identical for the two groups, given the greater age and ADL impairment of experimental subjects at pretest, is interpreted as suggestive of a possible beneficial effect of treatment which might warrant follow-up in a study with a larger sample size. Effects of treatment on functional status included a trend towards perception of improved social supports. mental health and physical health, as well as a significant decrease in unmet needs among experimental subjects (p < .05). Somewhat paradoxically, these beneficial changes were accompanied by a significant (p < .01) deterioration in Physical Activities of Daily Living. It is suggested that this change in PADL status may be confounded with the reception of the treatment which consisted of regular assistance with ADL tasks. Comparison of pre and post test hospitalization rates revealed no differences between the two groups, with the exception of the fact that fewer Five Hospital subjects were repeat users at pre and post test. A highly significant difference was observed in the rates of institutionalization for the two groups with experimental subjects experiencing this outcome less frequently than controls (p < .01). Multivariate analysis which attempted to control for selection differences and other explanatory variables failed to degrade this effect which remained significant. Furthermore. when the above outcome measures were analyzed according to level of treatment received, the same relationships described above were observed. The above findings were interpreted to indicate that, overall, the Program had beneficial effects on its clientele and that this model of long term care services has important implications for the development of national long term care policy.

Research on mental health outcomes among racial-ethnic, sexual, and gender minority young people indicates that they may be at increased risk for service use disparities when these identity statuses intersect. However, evidence of how having multiple minority identities is related to using mental health services is lacking. This dissertation used a mixed-methods, convergent design to explore and describe relationships between intersecting minority identities and mental health service use in the experiences of 31 Black and Hispanic, sexual and gender minority young adults. Consistent with an intersectional perspective, findings indicated that mental health service use was more strongly associated with minority identities collectively than with any single minority identity, and that experiences of intersecting minority identities could facilitate, as well as hinder, mental health service use among participants. A theoretical model was revealed in which participants negotiated multiple minority identities within four dimensions related to their service use: ethnic-racial culture, intersecting identities, family, and personal identities. Results suggested provider strategies that support intersecting minority identity strengths around culture, community belonging, and self-efficacy may encourage service use and engagement with treatment.

This dissertation examines gender pay disparity and women’s and men’s pay increase trajectories in a comparative analysis of the U.S. nonprofit and for-profit sectors. First, using the U.S. Censuses from 1990 and 2000, and the American Community Survey 2010-2014 data, this dissertation examines the nonprofit/for-profit difference in gender pay equity in Chapter 4. Traditionally, researchers have examined gender pay disparity across all industries in the entire economy combined. My analysis, however, focuses on 15 human service industries because nonprofit organizations are usually concentrated in those fields only. This empirical chapter makes two contributions to the field: first, it offers a more apples-to-apples comparison between pay in the nonprofit and for-profit sectors than previous research; second, it captures the gender pay disparity at three points in time, thus reflecting the change over the past 20 years. My industry-specific results challenge two normative assumptions: first, that nonprofits pay their workers lower than for-profits; and second, the smaller gender pay disparity in the nonprofit sector is a result of nonprofit pay compression. Leveraging theories from economics, sociology, and organizational studies, this empirical chapter pinpoints factors, such as industrial competition for labor, institutional pressures, level of unionization, and organizational form, that lead to a difference – or lack thereof – in the level of gender pay disparity between the two sectors. My second empirical chapter (Chapter 5) examines women’s and men’s pay increase trajectories in the nonprofit (NP) and for-profit (FP) sectors based on the Survey of Income and Program Participation 2008 panel data. This chapter traces the pay increases for four groups of workers: NP Stayers, FP Stayers, NP-FP Movers, and FP-NP Movers. The results show that there was selection in workers’ moving behaviors: NP-FP Movers tended to be those who were disadvantaged in the nonprofit sector, while FP-NP Movers tended to be those who were better off in the for-profit sector. The analysis does not find gender or sectoral difference in pay increase trajectories for workers who chose to stay in the same sector. This empirical chapter is the first attempt at tracing the pay trajectories of nonprofit and for-profit human service workers using longitudinal data.

This dissertation analyzes the effects of community violence on health care service utilization and access in Mexico. Given the widespread effects of violence, there is good reason to believe that health service delivery might be affected, but it is largely unknown. This study looks at potential channels through which violence may impact the supply and demand of health care services in Mexico, through qualitative and quantitative methods. It posits that violence can have heterogeneous effects on service utilization and provides a deeper exploration of factors that may have negative and positive effects on service utilization. Supply-side effects point towards deterring effects of violence in service utilization out of fear of travel and fear among medical staff to go to their workplaces or shortening the hours of operation out of fear of exposure. Mixed effects logistic regression models reveal demand-side effects through a significant increase in health care service utilization as violence increases possibly related to worsening health (e.g. through stress or other mechanisms), which may drive individuals to seek more services. In sensitivity analysis, increased primary care service utilization as a result of an increase in the homicide rate remains significant when predictors of service use such as having a chronic condition, insurance status and urban areas are included in the models. Qualitative findings also reveal an increased demand for mental health services at the primary care level as a result of increased community violence. Findings underscore the importance of access to outpatient services and mental health services at the primary care level in contexts of high violence. The significant increase in the use of outpatient service utilization point towards potentially protective behaviors driving the increase of use of services as violence increases. This analysis highlights the responsibility and need for providing safe access to medical services in contexts of violence that may translate to natural disasters or other man-made conflicts.

This study examines the role of collective identity in nonprofit coalition-building, using critical discourse analysis of a case study of an Asian American nonprofit organizational coalition focused on advocating for community health access and equity. The study finds that the pan-ethnic collective identity is a resource for the organizational coalition studied. The study extends existing literature on inter-organizational studies and nonprofit organizational coalition-building through the introduction of a conceptualization or model of identity work as involving both the activation and strategic deconstruction of the pan-ethnic Asian American collective identity. This study finds that identity work, as conceptualized, can be critical not only to sustaining a pan-ethnic coalition, but also to ensuring that a pan-ethnic coalition of nonprofit organizations embodies social work value of social justice and ethical responsibility of cultural competence and social diversity.

Thesis (Ph. D.)--Massachusetts Institute of Technology, Dept. of Urban Studies and Planning, 1982. / MICROFICHE COPY AVAILABLE IN ARCHIVES AND ROTCH / Vita. / Bibliography: leaves 261-267. / by Levi Amos Sorrell. / Ph.D.

Given the widely-accepted finding that countries with greater income inequality also experience less income mobility across generations (Corak, 2013; Krueger, 2012), it is expected that American mobility has decreased with rising income inequality in recent decades (Aaronson & Mazumder, 2008; Corak, 2013; Mazumder, 2012). However, mobility has remained unchanged (Chetty, Hendren, Kline, Saez, & Turner, 2014), and is unresponsive to changes in income inequality (Bloome, 2015). These findings raise questions as to why intergenerational income mobility in the U.S. has not fallen during the periods when income inequality has sharply risen. To address these questions, the dissertation focuses on two aims. The first aim is to examine the association between intergenerational income mobility and income inequality in the United States. The second aim is to examine intergenerational income mobility with respect to income inequality and government spending. The main data for this dissertation come from the National Longitudinal Study of Youth 1979 (NLSY79). The basic sample includes 4,824 parents-children pairs. I aggregate the state-level data from several different resources such as the IRS’s Statistics of Income, U.S. Census of Governments, and the U.S. Bureau of Labor Statistics. The state-level sample includes 220 state-year observations. Overall, the intergenerational elasticity (IGE) of income is about 0.43, and the analysis indicates that the US in reality is highly immobile, especially when looking at the extreme income groups of the bottom and the top. This study finds that rising income inequality acts to strengthen the importance of parental family income to child’s income. Particularly, the evidence that higher income inequality decreases intergenerational income mobility is clearer when migration problems are addressed. This study extends to include government spending and provides evidence that additional government spending contributes to promoting intergenerational income mobility. Moreover, government spending moderates the effects of income inequality on intergenerational income mobility. This evidence indicates that government spending plays a role in preventing the decrease in intergenerational income mobility by offsetting the consequences of income inequality on mobility. A number of sensitivity tests confirm that the main results are robust and reliable. However, these results are not uniform across the subgroups—defined by gender, race, and family structure. There are wide variations in the IGE, the effects of income inequality and government spending across the subgroups and by different income measures. The findings of this study have implications for social work policy and practice. Income inequality matters since it hinders the equal opportunity to succeed, especially for children from low-income families. This study demonstrates that government spending plays an important role in promoting intergenerational income mobility by offsetting the consequences of income inequality. Yet, this study does not claim that the effects of increased government spending for increased intergenerational mobility are limitless. Without efforts to connect low-income families to government policies and programs, economically disadvantaged children would not benefit in their human capital and skill development from increases in government spending.

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No. of bitstreams: 1 vitorino_bm_me_fran.pdf: 872994 bytes, checksum: c6704e8576031d1cffe1f4e682c48db3 (MD5) Previous issue date: 2016-08-30 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Considerando a adesão ao programa de expansão e reestruturação das Universidades Federais brasileiras, aprovado em 2009, a qual foi relevante para o contexto do país, no que diz respeito ao aumento de vagas na universidade, o presente trabalho visa a conhecer os impactos do programa Reuni na formação profissional do assistente social, assim como na permanência do estudante nessas universidades. Para tanto, realiza-se um estudo bibliográfico a respeito das atuais políticas de educação superior, com apoio de autores como Minto, Cunha, Tonet e Mészáros. Do mesmo modo, foi realizado também um estudo bibliográfico sobre a formação profissional dos assistentes sociais, que teve como apoio os autores Martinelli, Castro e Paulo Netto. Em seguida, foi feito um estudo de campo por meio de entrevistas semiestruturadas realizadas com as assistentes sociais da Universidade Federal do Triângulo Mineiro (UFTM), lotadas na pró-reitoria de assuntos estudantis e no departamento de Serviço Social. A partir dos estudos e entrevistas realizados, foi possível constatar que as mais recentes políticas de educação superior, com foco principal o Programa de Apoio à Planos de Reestruturação e Expansão das Universidades Federais (REUNI), muito contribuíram para expansão da universidade pública federal. Entretanto, fica nítido que o programa de reestruturação foi utilizado também para cumprir alguns interesses de ordem neoliberal, por isso alguns aspectos são enfrentados cotidianamente pelos entrevistados. Dentre eles, falta de recursos humanos e recursos materiais, falta de infraestrutura adequada aos novos cursos, insuficiência para manutenção e efetivação da permanência estudantil, entre outros aspectos que colocam em risco a formação profissional crítica, propositiva e generalista, como preveem as diretrizes curriculares da Associação Brasileira de Ensino e Pesquisa em Serviço Social (ABEPSS). Assim sendo, esses aspectos desafiam os profissionais que lutam cotidianamente por melhores condições de trabalho e por uma educação laica, pública de qualidade. / Considering joining the program of expansion and restructuring of Federal Universities Brazil, approved in 2009, which was of great relevance to the country context with regard to the increase in vacancies at the university, this paper aims to know the impact of the program I gathered the training of social service, as well as the student's stay in these universities. Therefore, there will be a bibliographic study on the current higher education policies, supported by authors such as Minto, Cunha, Tonet and Mészáros. Similarly, it was also carried out a bibliographic study on the training of social service, which was to support the authors Martinelli, Castro and Paulo Netto. Then he was made a field study through semi-structured interviews with social service Universidade Federal do Triângulo Mineiro (UFTM), crowded in the pro-rector for student affairs and Social Services Department. From the studies and interviews, it was possible to see that the latest higher education policies, with the main focus Programa de Apoio a Planos de Reestruturação e Expansão das Universidades Federais (REUNI), greatly contributed to the expansion of federal public university. However, it is clear that the restructuring program was also used to fulfill some interests of neoliberal order, so some aspects are faced daily by respondents. Among them, the lack of human and material resources, lack of adequate infrastructure to new courses, insufficient maintenance and effectiveness of the student residence, among other things that put at risk the critical professional training, proactive and generalist, as predict the curriculum guidelines Associação Brasileira de Ensino e Pesquisa em Serviço Social (ABEPSS). Therefore, these aspects challenge the professionals who fight daily for better working conditions and a secular education, public quality.

This research contributes to the relatively small collection of primary research exploring environmental social work. The research is qualitative in design and is underpinned by critical theory. Semi-structured interviews were carried out with 14 Welsh based, social work participants who all possessed a self-identified interest in environmental issues. The interviews elicited biographical narratives which were subject to thematic analysis. This gave insight into the development of such interests through childhood experiences, contact with nature and rural living. The underlying beliefs systems of participants were highlighted as political, spiritual and ecological awareness. The participants offered accounts of how social work and the natural environment were connected for them. The rural social work field shaped perspectives which were holistic and anti-discriminatory, containing evidence of structural understandings. Practice involving nature as a tool for individual change, food based initiatives and green work based behaviours emerged. The participants’ narratives are presented through a Bourdieusian lens. Barriers to integration were explored with notions of restrictiveness and disillusionment emerging from a neoliberal setting. The participants contributed to the development of the action stage. The action stage first, investigated the inclusion of the natural environment in the social work curricula in 5 Welsh Universities. The survey revealed a focus on individualised approaches being given priority with limited attention given to the wider environment. Phase two, involved the delivery of lectures on the subject of green social work in two universities. A post lecture evaluation form highlighted an interest in the subject amongst students as well as a perception of it being both relevant and of value to contemporary social work practice. Recommendations are made in relation to social work education, giving attention to food based initiatives and a reconsideration of community based social work with a focus on sustainability.

Thesis (M. A. (Social Work)) -- University of the North, 1983 / Refer to the document